From the Guidelines
Apixaban dosage should be decreased in patients who meet two out of three specific criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, with a reduced dose of 2.5 mg twice daily. The primary reasons for dose reduction are based on the patient's age, body weight, and renal function, as outlined in the 2024 ESC guidelines for the management of atrial fibrillation 1. These criteria are designed to balance the risk of thromboembolism with the risk of bleeding complications.
Key factors to consider when deciding to decrease apixaban dosage include:
- Age: patients aged 80 years or older may require a dose reduction due to increased risk of bleeding
- Body weight: patients with a body weight of 60 kg or less may require a dose reduction due to increased risk of bleeding
- Renal function: patients with serum creatinine levels of 133 mmol/L or higher may require a dose reduction due to decreased renal clearance of apixaban
It is essential to note that these criteria are not the only factors to consider when managing apixaban therapy. Regular monitoring of renal function, bleeding signs, and drug interactions is crucial to ensure the safe and effective use of apixaban 1. The 2024 ESC guidelines provide the most up-to-date and evidence-based recommendations for the management of atrial fibrillation, including the use of direct oral anticoagulants like apixaban.
In contrast to older studies, such as the 2012 American Heart Association/American Stroke Association science advisory 1, the 2024 ESC guidelines provide more specific and detailed recommendations for dose reduction based on patient characteristics. Therefore, the 2024 ESC guidelines should be prioritized when making decisions about apixaban dosage.
From the FDA Drug Label
For patients receiving apixaban 5 mg or 10 mg twice daily, the dose of apixaban should be decreased by 50% when coadministered with drugs that are combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) [see Dosage and Administration (2.5) and Clinical Pharmacology (12.3)]. For patients receiving apixaban at a dose of 2. 5 mg twice daily, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors [see Dosage and Administration (2.5) and Clinical Pharmacology (12.3)].
The reasons to decrease Apixaban (apixaban) are:
- Concomitant use of combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) in patients receiving apixaban 5 mg or 10 mg twice daily, which requires a 50% dose reduction.
- Concomitant use of combined P-gp and strong CYP3A4 inhibitors in patients receiving apixaban at a dose of 2.5 mg twice daily, which requires avoidance of coadministration 2, 2, 2.